Aubert, Carole E; Floriani, Carmen; Bauer, Douglas C; Da Costa, Bruno; Segna, Daniel; Blum, Manuel R; Collet, Tinh-Hai; Fink, Howard A; Cappola, Anne R; Syrogiannouli, Lamprini; Peeters, Robin P; Åsvold, Bjørn O; den Elzen, Wendy Pj; Luben, Robert N; Bremner, Alexandra P; Gogakos, Apostolos; Eastell, Richard; Kearney, Patricia M; Hoff, Mari; Le Blanc, Erin; ... (2017). Thyroid function tests in the reference range and fracture: individual participant analysis of prospective cohorts. Journal of clinical endocrinology and metabolism, 102(8), pp. 2719-2728. Endocrine Society 10.1210/jc.2017-00294
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Aubert JClinEndocrinolMetab 2017.pdf - Published Version Available under License Publisher holds Copyright. Download (291kB) | Preview |
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Context
Hyperthyroidism is associated with increased fracture risk, but it is not clear if lower TSH and higher free thyroxine (FT4) in euthyroid individuals are associated with fracture risk.
Objective
To evaluate the association of TSH and FT4 with incident fractures in euthyroid individuals.
Design
Individual participant data analysis.
Setting
Thirteen prospective cohort studies with baseline examinations between 1981 and 2002.
Participants
Adults with baseline TSH 0.45-4.49 mIU/L.
Main Outcome Measures
Primary outcome was incident hip fracture. Secondary outcomes were any, non-vertebral, and vertebral fractures. Results were presented as hazard ratios (HR) with 95% confidence interval (CI) adjusted for age and sex. For clinical relevance, we studied TSH according to five categories: 0.45-0.99mIU/L; 1.00-1.49mIU/L; 1.50-2.49mIU/L; 2.50-3.49mIU/L; 3.50-4.49mIU/L (reference). FT4 was assessed as study-specific standard deviation increase, because assays varied between cohorts.
Results
During 659,059 person-years, 2,565/56,835 participants had hip fracture (4.5%; 12 studies with data on hip fracture). The pooled adjusted HR (95% CI) for hip fracture was 1.25 (1.05-1.49) for TSH 0.45-0.99mIU/L, 1.19 (1.01-1.41) for TSH 1.00-1.49mIU/L, 1.09 (0.93-1.28) for TSH 1.50-2.49mIU/L, and 1.12 (0.94-1.33) for TSH 2.50-3.49mIU/L (P for trend = 0.004). Hip fracture was also associated with FT4 (HR [95%CI] 1.22 [1.11-1.35] per one standard deviation increase in FT4). FT4 only was associated with any and non-vertebral fracture. Results remained similar in sensitivity analyses.
Conclusions
Among euthyroid adults, lower TSH and higher FT4 are associated with an increased risk of hip fracture. These findings may help refine the definition of optimal ranges of thyroid function tests.
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